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BACKGROUND: The aim of this study was to evaluate the predictability and visual outcome of a foldable silicone iris-fixated phakic intraocular lens (Artiflex, Ophtec) for the correction of moderate to high myopia. PATIENTS AND METHODS: A retrospective cohort study with 34 eyes of 20 patients was undertaken. All patients underwent similar lens implantation with iris enclavation. The follow-up was 6 months. RESULTS: At the final visit, 81% of eyes were within 0.5 D of the target spherical equivalent. Intraocular lenses with -12.0 to -14.5 D power showed a mean overcorrection of +0.81 D. The highest mean overcorrection of +1.45 D was shown by the Artiflex lenses with -14.5 D of power. The postoperative refraction remained stable, but the postoperative uncorrected and best-corrected visual acuity increased over time. 56% of eyes gained 1 or more Snellen lines of best-corrected visual acuity; one eye lost one line. No intraoperative complication was noticed. Two eyes showed prolonged intraocular inflammation. CONCLUSIONS: The implantation of the phakic Artiflex intraocular lens was safe and showed a good predictability and safety for the correction of moderate to high myopia. It is an efficient alternative for laser in-situ keratomileusis, especially in high myopia, leading to a stable refraction one month postoperatively.

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The prevalence of infection, i.e. endemic infection with Mycobacterium tuberculosis, which was 100% in post-adolescent adults in 1900, had decreased to 23.1% by the year 1998. In Switzerland, on average 1100 active tuberculosis cases were diagnosed in hospitals (acute-care clinics) between 1990 and 1993. A mass X-ray fluoroscopic screening performed in 1943/44 by the Swiss Army detected 967 cases of active tuberculosis, corresponding to 1.9 per thousand of the fluoroscopically screened subjects. In 2000, photofluorography examinations performed on asylum seekers detected 3.25 per thousand cases of active tuberculosis. Since the beginning of 2006, these examinations have no longer been performed to save costs. Back in 1890, 6639 of the patients died of tuberculosis; by 2001, this number had dropped to an incredibly low 22. Our present aim must now be to prevent the primary infections that will later lead to tuberculosis in 5-8% of the cases. Consequently, we will not be able to eradicate tuberculosis in Switzerland for two to three more decades; a feat that might not even be accomplished within in a century in the developing countries.

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PURPOSE: A survey was sent to all members of the German Society of Ophthalmic Surgeons to evaluate complications that required explantation of foldable intraocular lenses (IOLs). METHODS: Data on preoperative visual acuity, foldable IOL design and material, and the reason for explantation were obtained and analysed. We received 185 surveys for 2000 and 2001. RESULTS: In 2000 and 2001, the most common reasons for IOL explantation were: incorrect lens power (31%) and dislocation (19%) in three-piece acrylic IOLs, incorrect power (31%) and decentration (17%) in monofocal silicone IOLs, and opacification (46%) in hydrophilic IOLs. The most common reasons for the exchange of monofocal IOLs were lens opacification in 2000 and incorrect IOL power in 2001. CONCLUSION: Besides the most frequent complications of decentration and incorrect power observed in rigid IOLs,new complications associated with foldable IOLs occurred (e.g., optic opacification and calcification). Accurate calculation of IOL power and further improvements in material and design are still necessary to minimize the rate of explantations.

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PURPOSE: A questionnaire was sent to all members of the German Society of Ophthalmic Surgeons to evaluate complications of foldable intraocular lenses (IOLs) that required explanation. METHODS: Information on preoperative visual acuity, foldable IOL design and material as well as the reason for IOL explantation was obtained and analysed. We received 167 completed questionnaires for 1998 and 1999. RESULTS: In 1998 and 1999 the most common reasons for IOL explantation were as follows: incorrect lens power for 56% of the 3-piece hydrophobic acrylic IOLs, 16% because of glare or other photic phenomena, 40% of the 1-piece hydrophilic acrylic IOLs were explanted because of incorrect lens power and 30% for IOL damage. For the 3-piece monofocal silicone IOLs, 41% were explanted because of incorrect IOL power and 32% because of IOL decentration. For the 1-piece Hydrogel IOL, 76% were explanted because of opacification of the optic and 14% because of incorrect lens power. Most multifocal IOLs were explanted because of photic phenomena. CONCLUSION: In addition to the most common complications such as decentration and incorrect IOL power observed in rigid IOLs, new complications associated with foldable IOLs occurred such as optic opacification, glare and photic phenomena. Some complications seemed to appear in particular IOL types (opacification: SC-60BOUV, MDR), while others were observed in all types of foldable lenses. Accurate calculation of the IOL power and further improvement of the IOL material and design seem to be necessary to minimise the rate of explantations.

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For tuberculosis the prevalence of infection, i.e. the rate of occurrence of infection among the population, is one essential measure in defining the profile of this endemic disease. The present account is based primarily on a set of tuberculin-test records which was compiled as the result of periodic BCG inoculation programmes on over 200,000 people tested in the Zurich Canton. In our analysis figures from the period from 1950 to 1978 were included. Longitudinal sections indicate infection profiles within, for example, birth cohorts (BC), i.e. groups of people of the same age. According to various investigations by our group, the principle of the theory advanced by K. Styblo et al (1969), which is based on figures from the Netherlands, also applies to Swiss conditions. According to this, the progress of infection rate with time, in terms of the percentage incidence within the age scale of each BC, follows a rigid pattern. Quantitatively there are differences between the Netherlands and Swiss results. Where in the Netherlands within a particular BC relative percentages (R%) of 40 R% for 4-year olds, 82 R% for 14-year olds and 95 R% for 24-year olds occur--compared to the maximum figure of 100% relative per cent for 50-year-olds--the comparable figures for Switzerland are 24.4 R%, 48.9 R% and 85 R%. Irrespective of the size of the observed, actual infection rate, its progress follows this rigid pattern. Wiping out tuberculosis without eliminating the sum of infection prevalence accumulated in the population as a result of earlier tuberculosis infections is inconceivable. According to extrapolations, the prevalence will still be 12.5% in our country in the year 2028. It will probably take several decades yet to eradicate tuberculosis in Switzerland.

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Army mass X-ray fluoroscopic screening (ARD) included the group of service personnel performing its military service in the Swiss army in the years 1943/44. ARD was at that time regarded as a measure targeted against tuberculosis, and was ordered by the Chief of the General Staff, at the request of the Head of the Army Medical Service. A total of 516,879 conscripts were examined. Of these--corresponding to the structure of the army--the infantry with 265,640 conscripts made up 51.4% of those examined in this way. As a result a total of 967 cases of active pulmonary tuberculosis were discovered and recorded in the army. This total was made up of 395 so-called active-open and 572 active-closed cases. Inactive pulmonary tuberculosis of the lungs occurred in 1,642 conscripts. The total number of 967 carriers of an active pulmonary tuberculosis corresponded--when converted--to an incidence of 187/100,000 persons. The 6,186 cases of hardened primary complexes, further multiple hardenings in the lung and pleuritic adhesions, probably mostly of tuberculous origin at that time, recorded in addition during the mass screening may also be regarded as evidence of a considerable "epidemic resistance" among military personnel. In comparison to foreign European armies--though with smaller numbers examined--the Swiss figures are lower.

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The medical statistics of VESKA (Association of Swiss Hospitals), MSV, comprise and include the spectrum of all diseases in patients admitted to Swiss hospitals which are members of the association. Documentation is carried out in accordance with the WHO ICD code. Tuberculosis is registered under the main figures 010 to 018. The MSV makes an essential contribution in a special area to the recording of tuberculosis in Switzerland. The ICD code classes the disease either in positions 1 to 3 as the category of "all (TB) diagnoses' or as "principal diagnosis' in the first place. The numerical values are either recorded individually for the years 1990 to 1993 or as mean values of these four years. Tuberculosis occupies a small space within the overall statistics. Of a total of 722 868 and 369 840 coded diagnoses (1990 to 1993, averages), 1100 and 627, respectively, fall under tuberculosis in the two categories. This corresponds to a proportion of 0.15% and 0.17%, respectively. Tuberculosis becomes more important because the general average hospital stay of 12.7 days is almost doubled with an average of 24.7 days for tuberculosis patients. If the costs per case generally stand at Sfr. 7353.-, then, for tuberculosis patients, they rise to Sfr. 14 301.-. The overall costs for tuberculosis patients per calendar year total Sfr. 15 731 430.- and Sfr. 8 966 915.-, respectively, in the two categories. Tuberculosis is, therefore, a disease which is still of economic significance even in Switzerland. In the category of types of tuberculosis, pulmonary tuberculosis (011) still today occupies first position compared to previous analyses with current figures of 65.1% and 67.7% respectively. In the case of the extra-pulmonary types, uro-genital tuberculosis (016) stands in second place with 5.7% and 3.5% in the two categories, after the group of tuberculosis of other organs (017) with 5.9% and 6.1%, respectively. There was a constant preponderance of male over female patients (64.3% vs. 35.6%). If decades ago tuberculosis shifted to and was spread over more advanced age groups in Switzerland, the proportion of foreigners now within the whole population has brought about a change. Almost twice as many tuberculosis cases occur within the 20-year to 40-year age group than in the other age groups, in which a certain degree of levelling off is apparent. From comparisons of notifications to authorities in Switzerland and from hospitalization rates, it can be deduced that there is no increased need for hospitalization for any particular age group.

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BACKGROUND: After accommodative changes of endocapsular silicone lenses in presenile nonhuman primates had been confirmed by several authors, this pilot study was designed to evaluate the ability of an artificial lens to restore accommodation in the senile eye of a rhesus monkey that had previously lost most of its accommodative capability. METHODS: An injectable silicone lens was implanted in one eye of six rhesus monkeys who were older than 17 years. Accommodation was documented as the amount of decrease of anterior chamber depth after pilocarpine stimulation. RESULTS: Four months after surgery, the decrease of anterior chamber depth was higher in the operated eye with the silicone intraocular lens in the two monkeys who had marked presbyopic changes in the natural lens. One monkey was kept for more than 4 years, retaining a decrease of at least 0.5 mm with the silicone lens, whereas the natural lens failed to show any accommodative change. CONCLUSIONS: These findings support recent reports that presbyopia is primarily a consequence of lenticular aging rather than ciliary muscle factors. A pliable injected lens may therefore have the potential to restore accommodation in the senile primate eye.

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Despite a wide spectrum of efficient chemotherapies, tuberculosis patients even today are often given inpatient treatment. This fact is shown by the MSV, the Medical Statistics of VESKA (Association of Swiss Hospitals), which is coded according to the ICD key and numbers tuberculosis forms from 010 to 018. The MSV figures for the year 1990 in its associated clinics are: total diagnoses 685,204, principal diagnoses 346,671, number of nursing days 4,613,737 and average stay 13.3 days. At the same time, the following data were registered: total of 1009 hospitalizations with a tuberculosis diagnosis, including 555 patients with a principal diagnosis of tuberculosis. Hospitalizations due to tuberculosis as the principal diagnosis account for 13,995 nursing days, which corresponds to 0.3% of the total. The average hospital stay lasts 25.2 days. In both diagnosis groups, first place is occupied by pulmonary tuberculosis (011) with 67.0% and 70.5% respectively, and among the extrathoracic forms 013-018, urogenital tuberculosis (016) with 6.3% principal diagnosis. The cases with the principal diagnosis of tuberculosis generate (partly calculated, partly estimated) hospital costs of approximately Sfr. 4.9 million and a paid wage total of some Sfr. 1.5 million. In the case of secondary tuberculoses of the 2nd and 3rd position in the statistics, analogous sums of an estimated total of Sfr. 2.4 million are added. It is therefore safe to say that tuberculosis is still not without financial significance in Switzerland.(ABSTRACT TRUNCATED AT 250 WORDS)

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The mortality rate still is an important index for assessment of tuberculosis. Statistical records are kept on the mortality rate on a worldwide basis--more than in the case of other tuberculosis parameters. They allow us to make valuable comparisons. They are also useful because the mortality is closely related to the morbidity. The present thesis is based on comparative figures from the 1989 volume of the WHO Health Statistics Annual. Various countries have been specially selected by the publisher--and subsequently also by us--for sake of clarity. The figures vary strongly within these countries, which was to be expected. The mortality rate varies in Europe (for each 100,000 residents) e.g. from 0.2 in the Netherlands to 8.15 in the Soviet Union. In the Americas the rates vary from 0.4 for Canada to 12.9 for Ecuador. In the Western Pacific region the mortality rates vary from 0.35 for Australia to 14.65 for China. On a worldwide basis, the share of deaths from tuberculosis among all causes of death varies from 0.02% in the Netherlands to 2.10% in the Republic of Korea. The relation of tuberculosis deaths with regard to sexes in Switzerland: 75.7% men, 24.3% women, which is more or less the European average. The lower the mortality rate for tuberculosis are, the lower the difference between the sexes appears to be. Similar facts are found with regard to the distribution of tuberculosis deaths according to age groups: the lower the tuberculosis rate, the more tuberculosis is found in older age groups. The tuberculosis deaths are percentage-wise similarly distributed to the respiratory organs and the other tuberculosis forms.(ABSTRACT TRUNCATED AT 250 WORDS)

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During the last decade, the refugee population in less-developed countries has undergone unprecedented growth. High tuberculosis rates have been documented in refugees, particularly among those from Asia and Africa, generating interest in tuberculosis control efforts. To assess the tuberculosis burden among Vietnamese refugees, we screened refugees within 1 or 2 days after arrival in camps in Thailand and in the Philippines. Refugees in camps in Thailand were screened with chest radiographs. Persons with radiographic findings consistent with tuberculosis received microscopic and culture examination of sputum specimens. The prevalence of bacteriologically confirmed pulmonary tuberculosis was 5.8 per 1,000 refugees. Males had a higher risk than females (relative risk RR = 1.7, 95% confidence interval CI = 1.2 to 2.4). Refugees in the Philippines were given a tuberculin skin test. An annual risk of infection of 2.2% was calculated for this group. Males had a higher risk of infection (RR = 1.9, 95% CI = 1.5 to 2.4) than females. The age-specific prevalence of tuberculosis and the tuberculous infection increased with age. A high proportion of refugees (85%) with positive tuberculin skin tests were eligible for preventive therapy. Special efforts may be necessary to target Vietnamese refugees, as well as other persons originating from countries of high tuberculosis prevalence, for enhanced diagnostic and preventive intervention against tuberculosis to achieve the national goal of tuberculosis elimination by the year 2010.

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The tolerance of a multifocal diffraction contact lens was tested on the better eye (20/40) in a group of twenty cataract patients. The results were later compared with the postoperative tolerance of a multifocal diffraction intraocular lens. Patients manifesting problems with the multifocal contact lens are more likely to have problems with the multifocal intraocular lens. But since the intraocular lens is tolerated much better than the contact lens, this preoperative test would unnecessarily exclude some patients from the benefits of a multifocal diffraction intraocular lens.

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The Neuhann Capsulorhexis allows for a continuous, circular opening in the anterior lens capsule. After excavation of the lens matter the circular round edge in the anterior capsule provides maximum stability in the zonulolenticular diaphragm and facilitates controlled in-the-bag implantation of the lens haptic. Histologic studies of cadaver eyes have revealed that the correlation between the position of the lens loops as intended by the surgeon intraoperatively and their actual positioning is poor. It has therefore not been possible to prove the advantages of all-in-the-bag implantation as compared to sulcus fixation. The Neuhann Capsulorhexis reduces the morphological variability of the anterior capsule; furthermore, the position of the lens haptic can easily be determined both intraoperatively as well as postoperatively. This is a prerequisite for evaluating the best position for the lens haptic as well as for clinical evaluation of new types of intraocular lens.

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In owl monkeys, as a model of endocapsular cataract extraction, the lens material was removed through a small hole in the capsule and was replaced with a silicone polymeric gel. The ability of this endocapsular implant (Phaco-Ersatz) to accommodate was documented when pilocarpine produced an increase in the curvature of the lens surface and a decrease in the anterior chamber depth, just as occurs with the untouched natural lens. Refinements of the surgical technique are required to achieve a controlled degree of filling of the capsular bag and inhibit postoperative epithelial proliferation on the inner capsular surface.

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The size of macular scotomata is determined numerically by a series of parallel F2 programs of the Octopus Perimeter. As long as useful foveolar fixation is maintained, the results are reproducible within the limits due to fluctuation of the retinal sensitivity. The scotomata can be mapped on a fundus photograph either by direct calculation or after perimetric determination of a reference distance, e.g., foveola-disc or between angioscotomata. This method furnishes useful information which can facilitate evaluation of different types of lasers in macular photocoagulation.

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The evaluation of 404 consecutively implanted posterior-chamber intraocular lenses after extra-capsular cataract extraction revealed a mean post-operative refractive error of + 0.52 diopters with a standard deviation of +/- 1.27 diopters. Four calculations attracted attention because of their unusually high refractive error of + 3.4 diopters. A post-operative refractive balance excluded measurement or calculation errors. On the other hand, repeated axial length measurements on these four eyes showed a very high mean variation of 3.27 mm. This high variation can be correlated to such typical elevation changes of the central fundus as a tilted disc or posterior staphyloma. High axial length measurements which do not correspond to appropriate amounts of axial myopia should be handled carefully to avoid high amounts of hyperopia following intraocular implantation.

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